Summary The featured analysis estimated the proportions of deaths among 15–64-year-old residents of the European Union due to drinking, heavy drinking and alcohol dependence, then how many of these deaths would be averted by if varying proportions of dependent drinkers (from 10% to 40%) were engaged in different types of treatments or brief interventions. The results give an indication of the lives which might be saved if treatment was extended to more of the dependent population. The interventions considered were: among alcohol treatment caseloads, prescribing acamprosate or opioid antagonists like naltrexone, motivational interviewing, or cognitive-behavioural therapy; and among hospital inpatients identified as heavy drinkers while being treated for other conditions, brief interventions.

Dependent drinkers entering treatment were assumed to be among the heaviest drinkers in each country. Their consumption was estimated to fall as a result of treatment by amounts indicated in major reviews of treatment evaluation research. In turn this was estimated to reduce their risk of death due or partly due to alcohol. For the year 2004, the difference between the number of deaths due to untreated drinking versus the number expected if 10% to 40% of the heaviest and dependent drinkers were treated was the basis for calculating the proportion and number of alcohol-related deaths saved by treatment.

Main findings

Across the European Union it was calculated that about 86% of adults were drinkers, 9.4% heavy drinkers, and 3.5% dependent. After taking in to account health benefits of moderate drinking on diabetes and cardiovascular disease, in 2004 1 in 7 of all deaths in men and 1 in 13 among women were estimated to have been due to drinking. Nearly 8 in 10 of these deaths were due to heavy drinking and 7 in 10 due to dependent drinking.

Deaths were calculated to be most effectively averted by prescribing acamprosate or naltrexone and by brief interventions in hospitals. Compared to treatment being unavailable, had 40% of the heaviest and dependent drinkers been treated in these ways, it was estimated that in 2004 there would have been 13% fewer alcohol-related deaths among men and 9% fewer among women. These proportions equate to about 10,000 fewer deaths among men due to either treatment, 1700 fewer among women prescribed acamprosate or naltrexone, and 1500 fewer among women who participated in brief interventions in hospitals – in total, nearly 12,000 averted deaths. If just 10% were treated the corresponding figures would fall respectively to about 2500 for men, and for women just below 420 and about 370. In the longer term the number of deaths averted would be greater.

The authors’ conclusions

Mainly due to dependent drinking, alcohol causes a substantial degree of premature mortality in the European Union, but over 10% these deaths could be averted in a year by increasing alcohol dependence treatment capacity and coverage to 4 in 10 of the heaviest dependent drinkers.

I find these research studies fascinating because they give us hard numbers. So in 2004, and yes I appreciate this is over 10 years ago now, 1 in 7 of all deaths in men and 1 in 13 in women were estimated to be due to drinking. I find that a staggering number and if those kind of numbers appeared in another health condition there would be strategies implemented to bring that number down pretty swiftly!

Looking at Johann Hari’s works suggestion of diverting revenue currently used in law and order being used to fund more treatment interventions how much could be saved financially, and this is without even considering the more important human cost and the impact on all of those 12,000 families …….

Public Health England is carrying out its second annual survey of the residential rehabilitation sector. This follows last year’s survey and is being done against a background of continuing high-level interest about how the recent changes to healthcare and commissioning systems impact on the sector. The report based on last year’s survey can be found here